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Old 05-15-2012, 09:21 PM   #1
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Just had an Anterior Interbody Lumbar Fusion

Hello Everyone,

I am brand new on here and was looking for some advice. About 2 years ago I began to have horrible back pain, so much so that i barely got out of bed. Before this, I was in great shape, ran marathons, snowboarding, golf, etc...

In Sept of 2011, I had enough of the back pain and decided to do the fusion of L5 S1. When the doctor opened up my back, the noticed I had abnormal nerves in my back and he could not complete everything he wanted to do, but he was able to do some bone graft and put 4 pins in my back for stability. The recovery was awful and he suggested at the time to do it from the front to complete the surgery and everything he wanted to do. i said i would wait and see how this held up. Well, i felt ok at times, but the back pain was still there, so just last week on May 6th, I went in and he went through my stomach this time to put the cage into my back.

I am only 8 or 9 days post surgery and I don't have a clue what to expect. This second surgery was not nearly as bad as the first and I am able to walk and move around pretty well. i left the hospital about 24 hours after surgery, which i guess is pretty uncommon. he said i was in amazing shape and that i was free to go.

I was going to go back to work this week, as the incision on my stomach is almost healed up. But now my back is starting to hurt again.

Does anyone have a timeline on when I might start to feel better? I do quite a bit of sitting around the house, but i guess i shouldn't be doing that. I also am driving around town, but never too far.

Am i rushing things too much right now? I am taking it pretty easy overall, lots of laying in bed.

any advice or feedback on a time frame on when I should feel better would be greatly appreciated!

I have been icing my back as much as I can and going on walks around town and down to the beach.

Thank you!

 
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Old 05-15-2012, 11:12 PM   #2
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Re: Just had an Anterior Interbody Lumbar Fusion

I had an ALIF in December 2011. Similar story -- no high impact activities because of my bum hip but still swimming a mile+ three-four times a week up until the week before my surgery. The morning after the ALIF, the surgeon walked into my hospital room and said that, apart from the IV in my arm, I had no signs of having surgery the day before. (I spent two nights in the hospital, but would have left after one night if I had been able to pass gas any earlier.)

I took four weeks off, mostly to bask in the glory of not having to work. You definitely want to limit your time sitting to 15-20 minutes at a time. You should also make sure to take short walks as frequently as possible. Don't overdo anything! It's okay to allow yourself to take a break.

It took some time for my stamina to return, so, when I was ready, I started working part-time, often from home. That way, I could sit, stand, and lie down. If you have the option of working part-time, I would recommend easing back into work. Of course, your return to work will depend on the type of work you perform, but I am guessing you are in a desk job?

 
Old 05-16-2012, 06:37 AM   #3
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Re: Just had an Anterior Interbody Lumbar Fusion

Welcome to the board. Due to the fact that you are probably mostly fused from the first s urgery, I would think the recovery from this second surgery should be mostly from the surgery itself. Not knowing what was done the first time makes it difficult to say what recovery will be like this time.

Did your surgeon give you any restrictions or just what did he tell you in terms of restrictions.

As SweetPea said, you should still consider walking your most important activity at this point. Keep in mind, you are not walking for aerobic exercise! The point of walking is that it is the best way to stretch out the spinal nerves. You want to walk short distances frequently as this helps to keep scar tissue from attaching to the nerves as it fills in and forms. Scar tissue can be a major problem, particularly in revision surgeries.

Sometimes people who are physically fit and active prior to surgery feel that walking isn't enough exercise for them, and they neglect doing it. But in reality, even if you are capable of doing something more strenuous, walking on a level surface remains the most effective way to stretch out those nerves.

If you were a typical fusion patient undergoing an ALIF for the first time, you would probably be off work for six to eight weeks if you have a desk job. You would probably start feeling more energetic and "like yourself" around 12 weeks and pretty much back to normal by six months....But it takes a full year for the fusion to set up strong and for the bone to completely fill in, cure and harden up. Of course during the early weeks, you must avoid bending or twisting at the waist, reaching up overhead, or to the side, pushing, pulling and you should not lift anything heavier than the pound restriction given to you by your surgeon. I would suggest you limit how much you are driving. The position of driving puts stress on the sciatic nerve and is stressful to the discs as well, plus even though it may not be noticeable, your muscles are tensing and guarding your spine with every small movement of the car...braking, cornering, etc.

The healing process of a fusion is very similar to that of a broken bone. The difference is that with most large broken bones, there is a cast applied to the area that insures the two ends that are supposed to knit together are immobilized. Since we cannot do that with the spine, it is up to the patient to create as quiet a situation as possible, to immobilize that area as much as possible so it can heal.

Good luck to you. I hope this surgery resolves your pain.

 
Old 05-16-2012, 09:04 AM   #4
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Re: Just had an Anterior Interbody Lumbar Fusion

Thank you both so much for the insight, I really appreciate you taking the time out to help explain things better.

Did either of you start to feel the pain lessen at any point? I guess this was far more major of a surgery than I was willing to admit, especially the recovery period. I keep praying i am just going to wake up in the morning with no pain, but after only being out of surgery for 9 days, I may have wishful thinking.

I am a commercial insurance broker, so I spend a lot of time in the car and in meetings, as well as at the desk. It sounds like what I do for work isn't going to make things easy. Luckily I can work from home for the most part and my clients and company understand my situtaion.

I would love to find a timeline of somebody's elses experience with this surgery.....so I can see how I stack up.

Back pain is the worst thing I have ever been through. I would rather be dead somedays, but I have to trust this will all work out in the end.

 
Old 05-16-2012, 10:33 AM   #5
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Re: Just had an Anterior Interbody Lumbar Fusion

Could you give us a little more information? It is possible to have a fusion when the surgeon has only gone in from the back. Both of mine were done that way, but the surgeon had not been planning on also going in from the front. With my PLIF at L4-L5, I had a PEEK cage, BMP, rods and screws done from the back.

Was your first surgery complete and you didn't fuse or how did your nerves affect the surgery?

I don't know if the ALIF was to reenforce the first surgery, or if the first surgery failed and now the ALIF was done as a revision surgery, and thus, would be like anyone else having ALIF for the first time.

I guess in a way it really doesn't matter because we cannot really answer you anyway. Everyone heals at a different rate, experiences pain differently, etc.

With my first surgery I was quite laid up and on heavy pain meds for the first 8 weeks. By three months I was well enough to fly across the country and look at real estate for 5 days! With the second surgery, which was a 3 level fusion, I was pain-free on the 4th day. I did a very slow rehab because I did not want to do any activity that might cause my sciatic pain to return...but I've never looked back since that 4th day.

With the first fusion, I was in pretty bad shape because pain had kept me from walking for several years...and it took me a good 6 months to get energy back. With the 2nd fusion, I was in better shape going into it, and I wasn't nearly as exhausted. I think part of that may be from the pain meds, too. I didn't take them with the second surgery beyond the 10th day, so maybe that's why I had more energy.

I think it is quite normal to feel like you've been hit by a truck for many weeks -- like six to eight weeks. Then you should start feeling better even if it is just by a teeny little bit every week. If you get to three months post surgery and start feeling worse, that is an indication that something may still be wrong.

Regarding your job, you will just have to plan your schedule so you are leaving yourself more time to drive to your appointments, etc. You should really make time to get out of the car and stretch at least every half hour...same with sitting at home. Really until probably at least six weeks, you shouldn't sit for more than 15-20 minutes at one time. Sitting puts 30% more stress on the discs so it is important to follow these limitations.

 
Old 05-17-2012, 06:55 AM   #6
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Re: Just had an Anterior Interbody Lumbar Fusion

Thank you again for all the messages.

I was supposed to have the cage/fusion in my L5 S1 the first time I had surgery back in September 2011. When the surgeon went into my back, he noticed i had abnormal anotomy with my nerves, had he tried to put the cage in, he would have risked me losing movement in my foot. He was able to put four pins in at that time and he did some connected of the bone marrow. that is about all i know..... he told me right after that he couldn't do what he wanted because of the exposed nerves. I had also not gone to the sperm bank, which is why he tried through my back... apparently there is a low rate of non ejackulating after the front side surgery. SO on May 6th, the pain was still bad enough and he went through my stomach......I went to the sperm bank and he said he was able to put the cage in and the screws were already in, so I had the full procedure done in two attempts. I hope that helps explain my situation.

I am still in a ton of pain, 11 days after surgery. I mean I can walk around and do things, but when i wake up in the morning, i just want to scream. It hurts like hell just to sit here at the computer. Is it still healing? I just hope I don't have to live like this forever....

 
Old 05-17-2012, 09:41 AM   #7
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Re: Just had an Anterior Interbody Lumbar Fusion

It sounds like your doctor is both thorough and careful: good traits in a doctor.

You are still super-early in your recovery. At 11 days post-op, I was not sitting much. I would sit in a tall (pub height) straight-backed chair with a pillow in my lumbar back, mostly just while I was eating. Otherwise, I would walk or lie down. Very, very little sitting, which is better for your recovery. My husband would laugh at me walking laps around the living room while watching TV.

I still have some pain and stiffness in the mornings, but nothing like I had right after surgery. Are you taking any muscle relaxants? If you take something at night before bed, you should feel better when you wake up. I have taken Skelaxin, Soma, and Flexeril. The Skelaxin is the weakest but carries the least "dopey" feeling for me. It is also now available in generic, so good news there. It gets better, I promise!

 
Old 05-20-2012, 07:04 AM   #8
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Re: Just had an Anterior Interbody Lumbar Fusion

Hi SweetPea

I am still taking percocet for the pain. It is always so painful in the morning. I did a ton of walking around yesterday and now I just had to put ice on my back the minute i woke up because "the dogs were barking"

is my body still healing? is the pain level at this point normal?

I seriously felt much better the first week after surgery than I did in the 2nd week. I am now entering my 3rd week as today is the 2 week date from surgery. I just want to be able to wake up and feel no pain. It wasn't nearly this bad before the 2nd surgery, so I am hoping I didn't have something done that was not needed.

Is it better to ice my back rather than use a heating pad? I can't figure out what is less painful overall.

where should i be right now comparatively to what you have experienced. I hope this is the healing process and things will get better. I can't continue to live my life this way!

 
Old 05-20-2012, 08:51 AM   #9
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Re: Just had an Anterior Interbody Lumbar Fusion

One thing you should be aware of is that steroids are used at the end of surgery to bathe the area. This is done to cut down on infection, inflammation, and to reduce the amount of pain felt immediately post surgery. Since it is somewhat long-lasting, it is given to help get the patient over the worst of the pain. So, it is helpful to know about this as it explains why a patient often suddenly feels worse around the tenth day post surgery.

This is often the point where the patient notices nerve pain that they thought had gone away after surgery, or when they suddenly notice they are in more pain. It is not that there is suddenly "new" pain. In reality it is the point where the healing clock is reset: the steroid has been used up and the person is now experiencing whatever pain there still is post surgery.

Inserting the cage involves a fair amount of pressure and I understand that any time bone is cut into, the recovery is more painful. It may be that your body experienced a larger amount of trauma than with your first procedure. In any case, you would be wise to stop comparing this surgery to your first one, and just learn to listen to your body.

Try not to do too much. As soon as you do, you start another cycle of inflammation that can take awhile to get back under control, and it definitely increases pain. When this happens repeatedly, you run the risk of the nerve itself eventually becoming inflamed which eventually can lead to scarring. So it no longer is a problem of tissue inflammation pushing on the nerve causing pain, but the nerve itself is the problem, and it can be nearly impossible to get this resolved once it occurs. It is much easier in the long run to move forward with baby steps and avoid these cycles of inflammation.

Try to just take things one day at a time. Don't worry about what was going on at this point with your last surgery. It is irrelevant. You are still very early in your recovery...so try to be patient and maintain a positive attitude. It really can make a difference. Walking remains your best form of activity. Just don't tire yourself out. Short, frequent walks are much more beneficial to the healing process. Sitting is usually limited to 15-20 minutes a session and the rest of your time would be spent lying down, reclining with the spine well-supported, standing or walking.

 
Old 05-20-2012, 10:11 AM   #10
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Re: Just had an Anterior Interbody Lumbar Fusion

Thanks for the reply Teter, makes sense about the steroids wearing off and the pain becoming previlent.

 
Old 05-20-2012, 01:43 PM   #11
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Re: Just had an Anterior Interbody Lumbar Fusion

Can anyone help me out with a position to get into to get comfortable? I feel like somebody has stabbed me with a machete and they are just turning it in circles. i have an adjustable bed that helps get my feet higher than my body, but nothing seems to be working right now. I have taken four percocets already today, they don't do anything.

Help?

 
Old 05-21-2012, 12:46 AM   #12
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Re: Just had an Anterior Interbody Lumbar Fusion

To answer an earlier question, at two weeks I was still using my walker outside of the house, walking 15-20 minutes three times per day, and not doing much else. It sounds like you are doing more and cutting back should help your discomfort.

I would recommend asking your doctor about a muscle relaxer still, especially if your pain is worst in the morning. This may allow you to use less pain meds. I would also use exclusively ice until your surgeon clears you to use heating pads.

Getting comfortable -- I bought a leg wedge to place under my knees to sleep on my back. With your adjustable bed, you should be able to simulate this, with maybe a tiny incline for your torso. I also found lying on my side with a pillow between the knees to be comfortable when I got tired of lying on my back. I have had some neck issues, so I have a cervical foam pillow. You can recreate the support by rolling up a small hand towel and placing it inside your pillowcase at the base of the pillow, where your neck lands.

You might want to try some stretching -- not the back directly, though! My first PT appt was around two-three weeks post-op and you might want to ask if you can start PT. (I wanted the hydrotherapy early.) By stretching, I mean lying on your back and using a strap/belt to pull one knee at a time toward your chest. Your hamstrings are probably also tight and can be stretched without involving your back. You need about two steps -- place one leg bent at the knee on the second step, with your foot fully bent toward the front of the calf. Lean forward using a wall/rail for support, keeping your back straight, and you should get a mild stretch in the hamstring. If anything hurts, stop right away!

If you have discomfort in your buttocks or mid/upper back, you can use a tennis ball placed between a wall and those areas to self-massage. I was doing similar on the floor before surgery and realized that using a wall gave me more control over the pressure. Post-op, I had a lot of stress between my shoulder blades and this self-massage helped immensely. Don't place the ball on the area of the surgery though!

 
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